Provider First Line Business Practice Location Address:
1220 EAST 3900 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 3E
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-685-7188
Provider Business Practice Location Address Fax Number:
801-685-8116
Provider Enumeration Date:
06/26/2006